CT SCANS BOOST ODDS FOR SMOKERS

Longtime smokers who get a CT scan once a year, like women who go for mammograms, can greatly increase their odds of surviving lung cancer -- to upward of 90 percent -- new research shows.

Lung cancer is now the deadliest cancer in both men and women, killing 164,000 in the United States every year.

An 11-year international study published in today's New England Journal of Medicine involving more than 31,500 people, including some from South Florida, screened smokers and others at high risk by taking CT scans of their lungs. Those whose tumors were caught early had a 10-year survival rate of 88 to 92 percent, compared with only 5 percent when tumors are not caught until they have spread.

Some critics said the study is not definitive because it did not compare the patients who received CT scans to a group who got X-rays and a group who had no scans. Ongoing studies in the United States and Europe will make those comparisons.

"The survival rates are certainly far above anything else reported, or in patients receiving 'the usual care,' and we don't need to screen the entire population, just those considered at risk," said Dr. Richard Thurer, who led the arm of the study at Jackson Memorial Hospital and the University of Miami Miller School of Medicine.

Thurer and the authors of the study compared the annual CT scan to women having mammograms to catch early breast cancers.

"We focused on people over 50 with [a smoking history] of one pack a day for 10 years, or two packs a day for 5 years. And they don't have to be current smokers. They may have smoked in the past and it added up to that," Thurer said. "And if they had a family history [of lung cancer] we would begin screening them at age 45."

The screening found lung cancer in 484 of the participants. Of the total, 412 had small, pea-size tumors that had not spread, which are considered stage 1 cancers.

Their overall 10-year survival rate was estimated at 88 percent. Among the 302 patients with Stage 1 tumors who underwent surgery within one month of diagnosis, the estimated 10-year survival rate was 92 percent, researchers reported.

Usually, only about 15 percent of lung cancers are caught at Stage 1 because the disease produces no symptoms until it is advanced and has spread.

Thurer said neither Medicare nor most private insurance plans cover lung CT scans unless there are symptoms that lead a doctor to think there is a problem.

Thurer said he hopes that eventually insurers will cover the procedure. "I would hope that this would follow the path of mammography where ultimately it was funded, but initially it wasn't," he said.

Jimmie Douglas, 64, of Miami, is among those who credit the study with catching his lung cancer early.

"My doctor insisted that I take a scan because I'm a smoker. I did it and we discovered I had cancer. It was about half as big as my fingernail. They removed it in November 2003," Douglas said.

The loan consultant said he started smoking at age 6 with his grandfather in England, where he grew up . He goes once a year for a follow-up CT scan to make sure the cancer has not returned.

"If your doctor determines you need a scan, take his or her advice, and get tested, get rid of the cancer, and stop smoking," Douglas said.

Andrew Cuddihy, programs director for the American Lung Association of Florida's south area office, said his organization helped to design the questionnaire used to decide who should be screened at Jackson, and offers stop-smoking information aimed at reducing lung-cancer deaths.

"I know they picked up some cases that probably wouldn't have shown up for some time," Cuddihy said.

" People have asked us whether smokers should get X-rays, and we don't recommend that because by the time you can see it on an X-ray, your survival isn't enhanced at all. And if you screen somebody who's smoking, and if nothing shows up, then they think, 'I can just keep smoking until it does,'" Cuddihy said.

But CT scans find cancers earlier than X-rays can, he said.

Nancy McVicar can be reached at nmcvicar@sun-sentinel.com or 954-356-4593.